Moore Kirsten J, Candy Bridget, Davis Sarah, Gola Anna, Harrington Jane, Kupeli Nuriye, Vickerstaff Victoria, King Michael, Leavey Gerard, Nazareth Irwin, Omar Rumana Z, Jones Louise, Sampson Elizabeth L
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
Division of Psychiatry, University College London, London, UK.
BMJ Open. 2017 Jul 10;7(6):e015515. doi: 10.1136/bmjopen-2016-015515.
Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven 'Compassion Intervention' to enhance end-of-life care in advanced dementia.
To (1) understand how the Intervention operated in nursing homes in different health economies; (2) collect preliminary outcome data and costs of an interdisciplinary care leader (ICL) to facilitate the Intervention; (3) check the Intervention caused no harm.
A naturalistic feasibility study of Intervention implementation for 6 months.
Two nursing homes in northern London, UK.
Thirty residents with advanced dementia were assessed of whom nine were recruited for data collection; four of these residents' family members were interviewed. Twenty-eight nursing home and external healthcare professionals participated in interviews at 7 (n=19), 11 (n=19) and 15 months (n=10).
An ICL led two core Intervention components: (1) integrated, interdisciplinary assessment and care; (2) education and support for paid and family carers.
Process and outcome data were collected. Symptoms were recorded monthly for recruited residents. Semistructured interviews were conducted at 7, 11 and 15 months with nursing home staff and external healthcare professionals and at 7 months with family carers. ICL hours were costed using Department of Health and Health Education England tariffs.
Contextual differences were identified between sites: nursing home 2 had lower involvement with external healthcare services. Core components were implemented at both sites but multidisciplinary meetings were only established in nursing home 1. The Intervention prompted improvements in advance care planning, pain management and person-centred care; we observed no harm. Six-month ICL costs were £18 255.
Implementation was feasible to differing degrees across sites, dependent on context. Our data inform future testing to identify the Intervention's effectiveness in improving end-of-life care in advanced dementia.
ClinicalTrials.gov:NCT02840318: Results.
许多痴呆症患者在养老院去世，但护理质量可能不尽人意。我们开发了理论驱动的“关爱干预措施”，以改善晚期痴呆症患者的临终护理。
（1）了解该干预措施在不同卫生经济环境下的养老院中是如何实施的；（2）收集跨学科护理负责人（ICL）的初步结果数据和成本，以推动该干预措施的实施；（3）检查该干预措施是否无害。
对干预措施实施6个月的自然主义可行性研究。
英国伦敦北部的两家养老院。
对30名晚期痴呆症患者进行了评估，其中9名被招募用于数据收集；对其中4名患者的家庭成员进行了访谈。28名养老院和外部医疗保健专业人员参与了在第7个月（n = 19）、第11个月（n = 19）和第15个月（n = 10）的访谈。
一名跨学科护理负责人主导两个核心干预组成部分：（1）综合、跨学科评估与护理；（2）为付费护理人员和家属提供教育与支持。
收集了过程和结果数据。每月记录招募患者的症状。在第7个月、第11个月和第15个月对养老院工作人员和外部医疗保健专业人员进行了半结构化访谈，并在第7个月对家属进行了访谈。使用英国卫生部和英国健康教育署的收费标准计算跨学科护理负责人的工作时长成本。
发现不同地点之间存在背景差异：养老院2与外部医疗服务的接触较少。两个地点都实施了核心组成部分，但多学科会议仅在养老院1中建立。该干预措施促进了预先护理计划、疼痛管理和以人为本护理方面的改善；我们未观察到有害影响。跨学科护理负责人6个月的成本为18255英镑。
根据具体情况，该干预措施在不同地点的实施具有不同程度的可行性。我们的数据为未来的测试提供了信息，以确定该干预措施在改善晚期痴呆症患者临终护理方面的有效性。
ClinicalTrials.gov:NCT028⁃40318:结果。
